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Hu X, Lu M, Wang Y, Luo Y, Zhou Y, Yang X, Min L, Tu C. 3D-Printed custom-made hemipelvic endoprosthetic reconstruction following periacetabular tumor resection: utilizing a novel classification system. BMC Musculoskelet Disord 2024; 25:384. [PMID: 38755628 PMCID: PMC11097426 DOI: 10.1186/s12891-024-07509-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Customized 3D-printed pelvic implants with a porous structure have revolutionized periacetabular pelvic defect reconstruction after tumor resection, offering improved osteointegration, long-term stability, and anatomical fit. However, the lack of an established classification system hampers implementation and progress. METHODS We formulated a novel classification system based on pelvic defect morphology and 3D-printed hemipelvis endoprostheses. It integrates surgical approach, osteotomy guide plate and prosthesis design, postoperative rehabilitation plans, and perioperative processes. RESULTS Retrospectively analyzing 60 patients (31 males, 29 females), we classified them into Type A (15 patients: Aa = 6, Ab = 9), Type B (27 patients: Ba = 15, Bb = 12), Type C (17 patients). All underwent customized osteotomy guide plate-assisted tumor resection and 3D-printed hemipelvic endoprosthesis reconstruction. Follow-up duration was median 36.5 ± 15.0 months (range, 6 to 74 months). The mean operating time was 430.0 ± 106.7 min, intraoperative blood loss 2018.3 ± 1305.6 ml, transfusion volume 2510.0 ± 1778.1 ml. Complications occurred in 13 patients (21.7%), including poor wound healing (10.0%), deep prosthesis infection (6.7%), hip dislocation (3.3%), screw fracture (1.7%), and interface loosening (1.7%). VAS score improved from 5.5 ± 1.4 to 1.7 ± 1.3, MSTS-93 score from 14.8 ± 2.5 to 23.0 ± 5.6. Implant osseointegration success rate was 98.5% (128/130), with one Type Ba patient experiencing distal prosthesis loosening. CONCLUSION The West China classification may supplement the Enneking and Dunham classification, enhancing interdisciplinary communication and surgical outcomes. However, further validation and wider adoption are required to confirm clinical effectiveness.
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Affiliation(s)
- Xin Hu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China
| | - Minxun Lu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China
| | - Yitian Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China
| | - Yi Luo
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China
| | - Yong Zhou
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China
| | - Xiao Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, Sichuan, 610064, People's Republic of China.
- Provincial Engineering Research Center for Biomaterials Genome of Sichuan, Sichuan University, Chengdu, 610064, China.
| | - Li Min
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China.
| | - Chongqi Tu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China
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Jamshidi K, Toloue Ghamari B, Ammar W, Mirzaei A. Outcomes of ilium and iliosacral Ewing's sarcoma resection reconstructed with tibial strut allograft. Bone Jt Open 2024; 5:385-393. [PMID: 38736406 PMCID: PMC11089335 DOI: 10.1302/2633-1462.55.bjo-2024-0049.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Aims Ilium is the most common site of pelvic Ewing's sarcoma (ES). Resection of the ilium and iliosacral joint causes pelvic disruption. However, the outcomes of resection and reconstruction are not well described. In this study, we report patients' outcomes after resection of the ilium and iliosacral ES and reconstruction with a tibial strut allograft. Methods Medical files of 43 patients with ilium and iliosacral ES who underwent surgical resection and reconstruction with a tibial strut allograft between January 2010 and October 2021 were reviewed. The lesions were classified into four resection zones: I1, I2, I3, and I4, based on the extent of resection. Functional outcomes, oncological outcomes, and surgical complications for each resection zone were of interest. Functional outcomes were assessed using a Musculoskeletal Tumor Society (MSTS) score and Toronto Extremity Salvage Score (TESS). Results The mean age of the patients was 17 years (SD 9.1). At a mean follow-up of 70.8 months (SD 50), the mean functional outcomes were 24.2 points (SD 6.3) for MSTS and 81 points (SD 11) for TESS. The mean MSTS and TESS scores were associated with the iliac resection zone (< 0.001). Nine patients (20.9%) had local recurrence. The recurrence was not associated with the zone of iliac resection (p = 0.324). The two-year disease-free survival of the patients was 69.4%. The mean time to graft union was longer in patients with the I4 resection zone (p < 0.001). The complication rate was 34.9%, and nerve palsy (11.6%) was the most common. The rate of surgical complications was not associated with the resection zone. Conclusion Reconstruction using tibial strut allograft is an efficient procedure after the resection of the ilium and iliosacral ES. Functional outcomes and complications of iliac ES depend on the resection zone, and inferior outcomes could be generally expected when more segments of the pelvic ring are resected, even if it is reconstructed.
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Affiliation(s)
- Khodamorad Jamshidi
- Department of Orthopaedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Toloue Ghamari
- Department of Orthopaedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Wael Ammar
- Department of Orthopaedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Department of Orthopaedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Broida SE, Tsoi KM, Rose PS, Ferguson PC, Griffin AM, Wunder JS, Houdek MT. Reconstruction following oncological iliosacral resection. Bone Joint J 2024; 106-B:93-98. [PMID: 38160693 DOI: 10.1302/0301-620x.106b1.bjj-2023-0594.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Aims The sacroiliac joint (SIJ) is the only mechanical connection between the axial skeleton and lower limbs. Following iliosacral resection, there is debate on whether reconstruction of the joint is necessary. There is a paucity of data comparing the outcomes of patients undergoing reconstruction and those who are not formally reconstructed. Methods A total of 60 patients (25 females, 35 males; mean age 39 years (SD 18)) undergoing iliosacral resection were reviewed. Most resections were performed for primary malignant tumours (n = 54; 90%). The mean follow-up for surviving patients was nine years (2 to 19). Results Overall, 27 patients (45%) were reconstructed, while 33 (55%) had no formal reconstruction. There was no difference in the use of chemotherapy (p = 1.000) or radiotherapy (p = 0.292) between the groups. Patients with no reconstruction had a mean larger tumour (11 cm (SD 5) vs 8 cm (SD 4); p = 0.014), mean shorter operating times (664 mins (SD 195) vs 1,324 mins (SD 381); p = 0.012), and required fewer blood units (8 (SD 7) vs 14 (SD 11); p = 0.012). Patients undergoing a reconstruction were more likely to have a deep infection (48% vs 12%; p = 0.003). Nine reconstructed patients had a hardware failure, with five requiring revision. Postoperatively 55 (92%) patients were ambulatory, with no difference in the proportion of ambulatory patients (89% vs 94%; p = 0.649) or mean Musculoskeletal Tumor Society Score (59% vs 65%; p = 0.349) score between patients who did or did not have a reconstruction. The ten-year disease-specific survival was 69%, with no difference between patients who were reconstructed and those who were not (78% vs 45%; p = 0.316). There was no difference in the rate of metastasis between the two groups (hazard ratio (HR) 2.78; p = 0.102). Conclusion Our results demonstrate that SIJ reconstruction is associated with longer operating times, greater need for blood transfusion, and more postoperative infections, without any improvement in functional outcomes when compared to patients who did not have formal SIJ reconstruction.
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Affiliation(s)
- Samuel E Broida
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kim M Tsoi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter C Ferguson
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
| | - Anthony M Griffin
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
| | - Jay S Wunder
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Hu X, Lu M, Zhang Y, Li Z, Wang J, Wang Y, Xing Z, Yang X, Tu C, Min L. Pelvic-girdle reconstruction with three-dimensional-printed endoprostheses after limb-salvage surgery for pelvic sarcomas: current landscape. Br J Surg 2023; 110:1712-1722. [PMID: 37824784 PMCID: PMC10638540 DOI: 10.1093/bjs/znad310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/25/2023] [Accepted: 09/09/2023] [Indexed: 10/14/2023]
Abstract
Resection of pelvic bone tumors and the subsequent reconstruction of the pelvic girdle pose challenges due to complex anatomy, load-bearing demands, and significant defects. 3D-printed implants have revolutionized pelvic girdle reconstruction by offering customized solutions, porous surface structures for precise resection with custom guides, and improved integration. Many tertiary medical centers have adopted 3Dprinted hemipelvic endoprostheses, leading to enhanced outcomes. However, most studies are limited to single centers, with a small number of cases and short follow-up periods. Additionally, the design of these implants often relies heavily on individual experience, resulting in a lack of uniformity and significant variation. To provide a comprehensive assessment of this technology, we conducted an analysis of existing literature, encompassing tumor resection classification, various types of prosthesis design, reconstruction concepts, and post-reconstruction functional outcomes.
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Affiliation(s)
- Xin Hu
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Minxun Lu
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Yuqi Zhang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Zhuangzhuang Li
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Wang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Yitian Wang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Zhengyi Xing
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
- Provincial Engineering Research Center for Biomaterials Genome of Sichuan, Sichuan University, Chengdu, China
| | - Xiao Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
- Provincial Engineering Research Center for Biomaterials Genome of Sichuan, Sichuan University, Chengdu, China
| | - Chongqi Tu
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Li Min
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
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Laitinen MK, Parry MC, Morris GV, Jeys LM. Pelvic bone sarcomas, prognostic factors, and treatment: A narrative review of the literature. Scand J Surg 2023; 112:206-215. [PMID: 37438963 DOI: 10.1177/14574969231181504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Primary sarcomas of bone are rare malignant mesenchymal tumors. The most common bone sarcomas are osteosarcoma, Ewing's sarcoma, and chondrosarcoma. The prognosis has improved over the years, but bone sarcomas are still life-threatening tumors that need a multidisciplinary approach for diagnosis and treatment. Bone sarcomas arising in the pelvis present a unique challenge to orthopedic oncologists due to the absence of natural anatomical barriers, the close proximity of vital neurovascular structures, and the high mechanical demands placed on any pelvic reconstruction following the excision of the tumor. While radiotherapy has an important role especially in Ewing's sarcoma and chemotherapy for both Ewing's sarcoma and osteosarcoma, surgery remains the main choice of treatment for all three entities. While external hemipelvectomy has remained one option, the main aim of surgery is limb salvage. After complete tumor resection, the bone defect needs to be reconstructed. Possibilities to reconstruct the defect include prosthetic or biological reconstruction. The method of reconstruction is dependent on the location of tumor and the surgery required for its removal. The aim of this article is to give an insight into pelvic bone sarcomas, their oncological and surgical outcomes, and the options for treatment based on the authors' experiences.
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Affiliation(s)
- Minna K Laitinen
- Helsinki University Hospital and University of Helsinki Helsinki Finland Bridge Hospital Haartmaninkatu 4 PL 370 00029 HUS
- The Royal Orthopaedic Hospital, Birmingham, UK
| | - Michael C Parry
- The Royal Orthopaedic Hospital, Birmingham, UK
- The Royal Orthopaedic Hospital, Birmingham, UK
| | - Guy V Morris
- The Royal Orthopaedic Hospital, Birmingham, UK
- The Royal Orthopaedic Hospital, Birmingham, UK
| | - Lee M Jeys
- The Royal Orthopaedic Hospital, Birmingham, UK
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Zoccali C, Conti S, Zoccali G, Cinotti G, Biagini R. Pelvic ring reconstruction with tibial allograft, screws and rods following enneking type I and IV resection of primary bone tumors. Surg Oncol 2023; 48:101923. [PMID: 36931178 DOI: 10.1016/j.suronc.2023.101923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/21/2023] [Accepted: 03/05/2023] [Indexed: 03/13/2023]
Abstract
INTRODUCTION Surgery of primary malignant tumors involving the sacroiliac joint requires wide resection, which often interrupts the pelvic ring. Nowadays, restoration of the pelvic ring to provide stability and which technique is most fitting remain subject to debate. The aim of this study is to evaluate the results of pelvic reconstruction with pedicle screw instrumentation and tibial allograft following Enneking Type I-IV resections. PATIENTS AND METHODS All patients who underwent reconstruction with tibial allograft, screws and rods after resection of areas I and IV for primary bone tumors between 2017 and 2022 were reviewed. Clinical and radiological characteristics, fusion rate and functional results were analyzed. The MSTS score and the TESS were used to evaluate functional results. RESULTS Seven patients were included in the study. Chondrosarcoma was the most common histology. Only four patients reported pain. No fractures were observed at tumor diagnosis. Computer-assisted navigation was used in six cases. Reconstruction was performed in four cases with a screw inserted in the homolateral L5 pedicle and in the ischium, in two cases with a screw in the homolateral L4 pedicle and another in the homolateral L5 pedicle, in the last case with two screws inserted in L4 and L5, one screw in the ischium and another one in the residual iliac wing. In this case a contralateral stabilization was also carried out. The spine screws and the iliac screws were connected with a rod. The mean follow-up for all 7 patients was 37 months. One patient (16.6%) died due to general complications not directly related to the surgery; while the others are alive and apparently free of disease. Complete fusion was obtained in four out of seven patients and the average time for fusion was 9 months. The average MSTS score and TESS were 58.7% and 57.8%, respectively. DISCUSSION The need for reconstruction is thoroughly debated in literature. The advantages of restoring posterior pelvis stability are the prevention of long-term pain associated with limb shortening and secondary scoliosis. Re-establishment of the pelvic ring can be achieved through synthetic, biologic or hybrid reconstructions. CONCLUSIONS More studies that assess the surgical consequences at long-term follow-up and help clarify the indications for reconstruction and the specific technique are necessary to confirm our preliminary results.
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Affiliation(s)
- Carmine Zoccali
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy; Oncological Orthopedics Department, IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Stefano Conti
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Giovanni Zoccali
- Plastic and Reconstructive Surgery, IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Gianluca Cinotti
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Roberto Biagini
- Oncological Orthopedics Department, IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
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Vega MM, Li G, Shourijeh MS, Ao D, Weinschenk RC, Patten C, Font-Llagunes JM, Lewis VO, Fregly BJ. Computational evaluation of psoas muscle influence on walking function following internal hemipelvectomy with reconstruction. Front Bioeng Biotechnol 2022; 10:855870. [PMID: 36246391 PMCID: PMC9559731 DOI: 10.3389/fbioe.2022.855870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
An emerging option for internal hemipelvectomy surgery is custom prosthesis reconstruction. This option typically recapitulates the resected pelvic bony anatomy with the goal of maximizing post-surgery walking function while minimizing recovery time. However, the current custom prosthesis design process does not account for the patient's post-surgery prosthesis and bone loading patterns, nor can it predict how different surgical or rehabilitation decisions (e.g., retention or removal of the psoas muscle, strengthening the psoas) will affect prosthesis durability and post-surgery walking function. These factors may contribute to the high observed failure rate for custom pelvic prostheses, discouraging orthopedic oncologists from pursuing this valuable treatment option. One possibility for addressing this problem is to simulate the complex interaction between surgical and rehabilitation decisions, post-surgery walking function, and custom pelvic prosthesis design using patient-specific neuromusculoskeletal models. As a first step toward developing this capability, this study used a personalized neuromusculoskeletal model and direct collocation optimal control to predict the impact of ipsilateral psoas muscle strength on walking function following internal hemipelvectomy with custom prosthesis reconstruction. The influence of the psoas muscle was targeted since retention of this important muscle can be surgically demanding for certain tumors, requiring additional time in the operating room. The post-surgery walking predictions emulated the most common surgical scenario encountered at MD Anderson Cancer Center in Houston. Simulated post-surgery psoas strengths included 0% (removed), 50% (weakened), 100% (maintained), and 150% (strengthened) of the pre-surgery value. However, only the 100% and 150% cases successfully converged to a complete gait cycle. When post-surgery psoas strength was maintained, clinical gait features were predicted, including increased stance width, decreased stride length, and increased lumbar bending towards the operated side. Furthermore, when post-surgery psoas strength was increased, stance width and stride length returned to pre-surgery values. These results suggest that retention and strengthening of the psoas muscle on the operated side may be important for maximizing post-surgery walking function. If future studies can validate this computational approach using post-surgery experimental walking data, the approach may eventually influence surgical, rehabilitation, and custom prosthesis design decisions to meet the unique clinical needs of pelvic sarcoma patients.
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Affiliation(s)
- Marleny M. Vega
- Rice Computational Neuromechanics Lab, Department of Mechanical Engineering, Rice University, Houston, TX, United States
| | - Geng Li
- Rice Computational Neuromechanics Lab, Department of Mechanical Engineering, Rice University, Houston, TX, United States
| | - Mohammad S. Shourijeh
- Rice Computational Neuromechanics Lab, Department of Mechanical Engineering, Rice University, Houston, TX, United States
| | - Di Ao
- Rice Computational Neuromechanics Lab, Department of Mechanical Engineering, Rice University, Houston, TX, United States
| | - Robert C. Weinschenk
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Carolynn Patten
- Biomechanics, Rehabilitation, and Integrative Neuroscience (BRaIN) Lab, UC Davis School of Medicine, Sacramento, CA, United States
- UC Davis Center for Neuroengineering and Medicine, University of California, Davis, CA, United States
- VA Northern California Health Care System, Martinez, CA, United States
| | - Josep M. Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
- Health Technologies and Innovation, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Valerae O. Lewis
- Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Benjamin J. Fregly
- Rice Computational Neuromechanics Lab, Department of Mechanical Engineering, Rice University, Houston, TX, United States
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Valente G, Benedetti MG, Paolis MD, Sambri A, Frisoni T, Leardini A, Donati DM, Taddei F. Long-term functional recovery in patients with custom-made 3D-printed anatomical pelvic prostheses following bone tumor excision. Gait Posture 2022; 97:73-79. [PMID: 35914386 DOI: 10.1016/j.gaitpost.2022.07.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anatomical custom-made prostheses make it possible to reconstruct complicated bone defects following excision of bone tumors, thanks to 3D-printed technology. To date, clinical measures have been used to report clinical-functional outcome and provide evidence for the effectiveness of this new surgical approach. However, there are no studies that quantified the achievable recovery during common activities by using instrumental clinical-functional evaluation in these patients. RESEARCH QUESTION What is the motor performance, functional outcome and quality of life in patients with custom-made 3D-printed pelvic prostheses following bone tumor? METHODS To analyze motor performance, six patients performed motion analysis during five motor activities at follow-up of 32 ± 18 months. Joint angles, ground reaction forces and joint moments of the operated and contralateral limbs were compared. On-off activity of lower-limb muscles were calculated from electromyography and compared to a healthy matched population. To analyze functional outcome and quality of life, differences in measured hip abductor strength between limbs were evaluated, as well as clinical-functional scores (Harris Hip Score, Barthel Index, Musculoskeletal Tumor Society score), and quality of life (SF-36 health survey). RESULTS We found only slight differences in joint kinematics when comparing operated and contralateral limb. The activity of gluteal muscles was normal, while hamstrings showed out-of-phase activities. Ground reaction forces and hip moments showed asymmetries between limbs, particularly in more demanding motor activities. We found a mean difference in hip abductor strength of 48 ± 82 N between limbs, good clinical-functional scores, and quality of life scores within normative. SIGNIFICANCE Our study showed optimal long-term results in functional recovery, mainly achieved through recovery of the gluteal function, although minor impairments were found, which may be considered for future improvement of this innovative surgery. The effect of a more loaded contralateral limb on internal loads and long-term performance of the implant remains unknown and deserves further investigation.
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Affiliation(s)
- Giordano Valente
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Massimiliano De Paolis
- Department of Orthopaedics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Andrea Sambri
- Department of Orthopaedics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Tommaso Frisoni
- Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | | | - Fulvia Taddei
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
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9
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Zavras AG, Fice MP, Dandu N, Munim MA, Colman MW. Comparison of Reconstruction Techniques Following Sacroiliac Tumor Resection: A Systematic Review. Ann Surg Oncol 2022; 29:7081-7091. [PMID: 35904659 DOI: 10.1245/s10434-022-11890-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/28/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although internal hemipelvectomies with sacroiliac resections are not traditionally reconstructed, surgeons are increasingly pursuing pelvic ring reconstruction to theoretically improve stability, function, and early ambulation. This study aims to systematically compare complications and functional and oncologic outcomes of sacroiliac resection with and without reconstruction. METHODS PubMed and MEDLINE were queried for studies published between January 1990 and October 2020 pertaining to sacroiliac neoplasm resection with subsequent reconstruction. Patient demographics, histopathologic diagnoses, reconstruction techniques, Musculoskeletal Tumor Society (MSTS) functional scores, and oncologic outcomes were pooled. RESULTS Twenty-three studies (201 patients) were included for analysis. Reconstruction was performed in 79.1% of patients, most commonly with nonvascularized autografts (45.8%). The overall complication rate was 54.8%; however, resection followed by reconstruction demonstrated significantly higher complication (62.3% versus 25.7%, p < 0.001) and infection rates (13.7% versus 0%, p = 0.020). Mean MSTS functional score trended higher in nonreconstructed patients (82% versus 71.6%). CONCLUSIONS Reconstruction after sacroiliac resection produced higher complication rates and poorer physical recovery when compared with nonreconstructed resection. This systematic review suggests that patients without spinopelvic junction instability may experience superior outcomes without reconstruction. Ultimately, the need to reconstruct the pelvic girdle depends on tumor size, prognosis, and functional goals.
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Affiliation(s)
- Athan G Zavras
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael P Fice
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Navya Dandu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mohammed A Munim
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew W Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
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10
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Du X, Wei H, Zhang B, Gao S, Li Z, Cheng Y, Fan Y, Zhou X, Yao W. Experience in utilizing a novel 3D digital model with CT and MRI fusion data in sarcoma evaluation and surgical planning. J Surg Oncol 2022; 126:1067-1073. [PMID: 35779067 DOI: 10.1002/jso.26999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/31/2022] [Accepted: 06/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess sarcoma margins with more accuracy and aid surgical planning, we constructed three-dimensional (3D) digital models with computed tomography(CT) and magnetic resonance imaging (MRI) image fusion data and validated the preciseness of the models by comparing them with 3D models constructed with CT only data. MATERIALS AND METHODS We retrospectively reviewed a consecutive set of patients treated in our center who were preoperatively evaluated with the fusion image model. Models based on fusion images or CT-only data were constructed. Volumes of both tumors were calculated and the tumors were overlapped to see the location of differences between the two models. RESULTS A consecutive 12 cases (4 male vs. 8 female) were included in this study. Most of the tumors were located in the pelvic bone or spine. The volume of the two tumor models was different and the differences were mainly in the peripheral region of the tumor. CONCLUSION CT and MRI fusion image 3D models are more accurate than models with CT-only data and can be very helpful in preoperative planning of sarcoma patients.
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Affiliation(s)
- Xinhui Du
- Bone and Soft Tissue Department, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.,Key Laboratory for Digital Assessment of Spinal-Pelvic Tumor and Surgical Aid Tools Design (Zhengzhou), Zhengzhou, Henan, China.,Key Laboratory for Perioperative Digital Assessment of Bone Tumors (Henan), Zhengzhou, Henan, China
| | - Hua Wei
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Boya Zhang
- Bone and Soft Tissue Department, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.,Key Laboratory for Digital Assessment of Spinal-Pelvic Tumor and Surgical Aid Tools Design (Zhengzhou), Zhengzhou, Henan, China.,Key Laboratory for Perioperative Digital Assessment of Bone Tumors (Henan), Zhengzhou, Henan, China
| | - Shilei Gao
- Bone and Soft Tissue Department, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.,Key Laboratory for Digital Assessment of Spinal-Pelvic Tumor and Surgical Aid Tools Design (Zhengzhou), Zhengzhou, Henan, China.,Key Laboratory for Perioperative Digital Assessment of Bone Tumors (Henan), Zhengzhou, Henan, China
| | - Zhehuang Li
- Bone and Soft Tissue Department, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.,Key Laboratory for Digital Assessment of Spinal-Pelvic Tumor and Surgical Aid Tools Design (Zhengzhou), Zhengzhou, Henan, China.,Key Laboratory for Perioperative Digital Assessment of Bone Tumors (Henan), Zhengzhou, Henan, China
| | - Yu Cheng
- Bone and Soft Tissue Department, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Yichao Fan
- Bone and Soft Tissue Department, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.,Key Laboratory for Digital Assessment of Spinal-Pelvic Tumor and Surgical Aid Tools Design (Zhengzhou), Zhengzhou, Henan, China.,Key Laboratory for Perioperative Digital Assessment of Bone Tumors (Henan), Zhengzhou, Henan, China
| | - Xiaotian Zhou
- Bone and Soft Tissue Department, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Weitao Yao
- Bone and Soft Tissue Department, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.,Key Laboratory for Digital Assessment of Spinal-Pelvic Tumor and Surgical Aid Tools Design (Zhengzhou), Zhengzhou, Henan, China.,Key Laboratory for Perioperative Digital Assessment of Bone Tumors (Henan), Zhengzhou, Henan, China
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11
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Errani C, Mavrogenis AF, Tsukamoto S. What's new in musculoskeletal oncology. BMC Musculoskelet Disord 2021; 22:704. [PMID: 34404379 PMCID: PMC8369444 DOI: 10.1186/s12891-021-04590-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 08/05/2021] [Indexed: 12/26/2022] Open
Abstract
We reviewed the recent literature related to primary musculoskeletal tumors and metastatic bone tumors. With regard to primary bone tumors, computer navigation systems and three-dimensional-printed prostheses seem to be new treatment options, especially in challenging anatomical locations, such as the sacrum and pelvis. Regarding the treatment of giant cell tumor of bone, recent studies have suggested that denosumab administration is related to a higher local recurrence rate following curettage, but a lower local recurrence rate following en bloc resection. In addition, there was no difference in the local recurrence rate at five years after surgery between short-term and long-term denosumab therapy. With regard to soft tissue tumors, percutaneous cryoablation appears to be a new treatment option for extra-abdominal desmoid tumors, with encouraging results. Regarding soft tissue sarcomas, a negative surgical margin of < 1 mm is sufficient to control local recurrence. Pexidartinib seems to be a promising systemic therapy for the treatment of tenosynovial giant cell tumors for which surgery is not expected to improve the function of the affected limb. Finally, the life expectancy of patients is the most important factor in determining the optimal surgical procedure for patients with impending or pathological fractures of the long bone due to metastatic bone tumors. Elevated C-reactive protein level was found to be an independent poor prognostic factor at 1 year after surgery for long bone metastases.
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Affiliation(s)
- Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Andreas F Mavrogenis
- First Department of Orthopedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Street Holargos, 15562, Athens, Greece
| | - Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Nara, 634-8521, Kashihara-city, Japan
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12
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Ji T, Chin BZJ, Tang X, Yang R, Guo W. Iliosacral Bone Tumor Resection Using Cannulated Screw-Guided Gigli Saw - A Novel Technique. World J Surg Oncol 2021; 19:243. [PMID: 34399773 PMCID: PMC8369724 DOI: 10.1186/s12957-021-02349-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adequate margins are technically difficult to achieve for malignant tumors involving the sacroiliac joint due to limited accessibility and viewing window. In order to address the technical difficulties faced in iliosacral tumor resection, we proposed a technique for precise osteotomy, which involved the use of canulated screws and Gigli saw (CSGS) that facilitated directional control, anteroposterior linkage of resection points and adequate surgical margins. The purpose of the current study was to evaluate whether CSGS technique facilitated sagittal osteotomy at sacral side, and were adequate surgical margins achieved? Also functional and oncological outcomes was determined along with the noteworthy complications. METHODS From April 2018 to November 2019, we retrospectively reviewed 15 patients who underwent resections for primary tumors of pelvis or sacrum necessitating iliosacral joint removal using the proposed CSGS technique. Chondrosarcoma was the most common diagnosis. The osteotomy site within sacrum was at ipsilateral ventral sacral foramina in 8 cases, midline of sacrum in 5 cases, and contralateral ventral sacral foramina and sacral ala with 1 case each. The average intraoperative blood loss was 3640 mL (range, 1200 and 6000 mL) with a mean operation duration of 7.4 hours (range, 5 to 12 hours). The mean follow-up was 23.0 months (range, 18 and 39 months) for alive patients. RESULTS Surgical margins were wide in 12 patients (80%), wide-contaminated in 1 patient (6.7%), and marginal in 2 patients (13.3%). R0 resection was achieved in 12 (80%) patients and R1 resection in 3 patients. There were three local recurrences (20%) occurred at a mean time of 11 months postoperatively. No local recurrence was observed at sacral osteotomy. The overall one-year and three-year survival rate was 86.7% and 72.7% respectively.Complications occurred in three patients. CONCLUSIONS The current study demonstrated that CSGS technique for tumor resection within the sacrum and pelvis was feasible and can achieve ideal resection accuracies. The use of CSGS was associated with high likelihood of negative margin resections in the current series. Intraoperative use of CSGS appeared to be technically straightforward and allowed achievement of planned surgical margins. It is worthwhile to consider the use of CSGS technique in resection of pelvic tumors with sacral invasion and iliosacral tumors, however further follow-up at mid to long-term is warranted to observe local recurrence rate.
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Affiliation(s)
- Tao Ji
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China
| | - Brian Z J Chin
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China.,University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, Singapore, National University Health System, Singapore, Singapore
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China
| | - Rongli Yang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China
| | - Wei Guo
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China.
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13
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Rigid reconstruction with periacetabular multiple screws after the resection of malignant pelvic tumours involving the sacroiliac joint. INTERNATIONAL ORTHOPAEDICS 2021; 45:1793-1802. [PMID: 34086124 DOI: 10.1007/s00264-021-05096-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Reconstruction of the pelvic ring after the resection of pelvic tumours involving the sacroiliac joint is challenging. Although pedicle screw and rod system reconstructions are commonly performed, failure at the early stage has been reported. Surgical procedures Reconstruction involving two or more strong anchor screws (iliac, ischial, and pubis screws) into the residual pelvis, connecting with at least two rods with minimal bending to the residual lumbosacral vertebra and contralateral pelvis. METHODS The above reconstruction was performed for six malignant bone and soft-tissue pelvic tumours requiring Enneking type I + IV resection. A double-barreled free non-vascularized fibular graft was used in all patients, except for one. Patients were followed up for a mean period of 51 months (range, 9 to 96 months), and peri-operative complications, implant failure within the follow-up period, and the clinical results of surgery were investigated. RESULTS The mean age of four females and two males at the initial surgery was 37.2 years. One patient developed a deep wound infection. Two patients died due to metastasis of the tumor. All patients were able to walk on their own within 12 weeks of surgery. There was no implant failure, except in two patients with contralateral lumbosacral rod fracture three and four years after surgery, for which one patient required rod replacement. CONCLUSIONS The incidence of implant failure, particularly around the resection site, was low, which may be attributed to multiple periacetabular screws and rods with minimal bending. Our rigid reconstruction method enables the rapid resumption of walking.
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Erol B, Sofulu O, Sirin E, Saglam F, Baysal O, Tetik C. Pelvic Ring Reconstruction After Iliac or Iliosacral Resection of Pediatric Pelvic Ewing Sarcoma: Use of a Double-Barreled Free Vascularized Fibular Graft and Minimal Spinal Instrumentation. J Bone Joint Surg Am 2021; 103:1000-1008. [PMID: 33770022 DOI: 10.2106/jbjs.20.01332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In patients undergoing iliosacral resections, pelvic ring reconstruction can maintain stability of the pelvis and spinal column, which is expected to achieve good functional outcomes. However, no optimal reconstruction method has been established. We aimed to analyze the outcome of pelvic ring reconstruction using double-barreled free vascularized fibular graft (FVFG) and internal fixation after iliosacral resections in children. METHODS We retrospectively reviewed 16 children with pelvic Ewing sarcoma who underwent pelvic ring reconstruction using double-barreled FVFG after iliosacral resection. The fibular graft was placed between the supraacetabular region distally and the remaining ilium or sacrum proximally. The stability of the remaining pelvis and spinal column was provided by minimal spinal instrumentation. RESULTS Eleven Type-I and 5 Type-I+IV resections were performed for 10 boys and 6 girls, who had a mean age of 13.4 years (range, 10 to 18 years). The mean follow-up was 49.8 months (range, 28 to 96 months). At the time of the final follow-up, 14 patients were alive and 2 patients had died of disease. The mean time for bone union was 9 months (range, 6 to 12 months). Graft hypertrophy was evident in all patients at 12 months. The median Musculoskeletal Tumor Society (MSTS) score at the time of the final follow-up was 80% (range, 60% to 96.6%). Seven patients had complications. Three complications required reoperation: 1 deep infection, 1 hematoma, and 1 wound dehiscence. Three patients had disease relapse in terms of lung metastases. CONCLUSIONS This reconstruction method can achieve a high rate of bone union and can provide good functional outcomes following resection of pediatric pelvic Ewing sarcomas with iliosacral involvement. Complications are usually manageable without a need for revision surgical procedures. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bulent Erol
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Omer Sofulu
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Evrim Sirin
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Fevzi Saglam
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ozgur Baysal
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Cihangir Tetik
- Departments of Orthopaedics and Traumatology, Acıbadem University Hospital, Istanbul, Turkey
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15
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Yu Z, Zhang W, Fang X, Tu C, Duan H. Pelvic Reconstruction With a Novel Three-Dimensional-Printed, Multimodality Imaging Based Endoprosthesis Following Enneking Type I + IV Resection. Front Oncol 2021; 11:629582. [PMID: 33928025 PMCID: PMC8078592 DOI: 10.3389/fonc.2021.629582] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/18/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND PURPOSE Pelvic tumor involving Type I + IV resections are technically challenging, along with various reconstructions methods presenting unsatisfactory outcomes and high complication rates. Since predominating studies preferred adopting pedicle screw-rod system (PRSS) to address this issue, we designed a novel three-dimensional-printed, multimodality imaging (3DMMI) based endoprosthesis with patient-specific instrument (PSI) assistance to facilitate the surgical reconstruction of pelvic tumor involving Enneking Type I + IV resection. We aimed to investigate the clinical effectiveness of this novel endoprosthesis and compare it with PRSS in Type I + IV reconstruction. METHODS We retrospective studied 28 patients for a median follow-up of 47 months (range, 10 to 128 months) in this study with either 3D-printed endoprosthesis reconstruction (n = 10) or PRSS reconstruction (n = 18) between January 2000 and December 2017. Preoperative 3DMMI technique was used for tumor evaluation, PSI design, virtual surgery, and endoprosthesis fabrication. Clinical, oncological outcomes, functional assessments, and complications were analyzed between the two groups. RESULTS Minor surgical trauma with mean operative duration of 251 ± 52.16 minutes (p = 0.034) and median intraoperative hemorrhage of 2000ml (range, 1600, 4000ml) (p = 0.032) was observed in endoprosthesis group. Wide margins were achieved in 9 patients of the endoprosthesis group compared with 10 in the PRSS group (p = 0.09). The 1993 version of the Musculoskeletal Tumor Society score (MSTS-93) was 23.9 ± 3.76 in endoprosthesis group, which was higher than PRSS group (p = 0.012). No statistical significance was found in relapse between two groups (p = 0.36). Complications were observed in two patients in endoprosthesis group compared with 12 patients in PRSS group (p = 0.046). CONCLUSION The novel design of this 3D-printed endoprosthesis, together with 3DMMI and PSI assisted, is technically accessible with favorable clinical outcomes compared with PRSS. Further study is essential to identify its long-term outcomes.
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Affiliation(s)
| | | | | | | | - Hong Duan
- West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
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16
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Affiliation(s)
- Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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